Provider Resource Center
Serving the OneCare network of health care professionals and clinicians
Find key dates, reference links and documents, compliance tips, and contact information.
Announcement
Business Closure Need-to-Know
As a reminder, OneCare will wind down operations by the end of this year.
To help our network prepare for the closure of OneCare Vermont, we have added a new section to the resource center with essential information. Some items may require action before year-end, while others are simply for your awareness. We will continue updating this section in the coming months—watch your inbox for direct emails from our team and our monthly Need-to-Know from Your ACO, released on the first Tuesday of each month.
Monthly E-Newsletter: Need-to-Know from Your ACO
At the beginning of each month OneCare sends an email to our network with important need-to-know information and links necessary to be successful in the OneCare accountable care organization, supporting health care delivery reform across the continuum of care.
Recent newsletters:
Quality Measures
2025 Annual Quality Measures
| 2025 Quality Measure | Medicare | Medicaid | Self-Funded | MVP QHP | PHM Measure |
|---|---|---|---|---|---|
| Follow-Up after Discharge from the ED for Mental Health or Alcohol or Other Drug Dependence (30-Day) (NQF#2605) | Yes | – | – | – | – |
| Follow-Up after ED Visit for Substance Use – 30-Day (HEDIS FUA) | – | Yes | – | Yes | Yes |
| Follow-Up after ED Visit for Mental Illness -30 Day (HEDIS FUM) | – | Yes | – | Yes | Yes |
| Hospital-Wide, 30 Day, All Cause Unplanned Readmission (Quality ID#479) | Yes | – | – | – | – |
| Clinician and Clinican Group Risk-Standardized Acute-Admission Rate for Patients with Multiple Chronic Conditions (Quality ID#484) | Yes | – | – | – | – |
| Risk Standardized, Hospital Admission Rate for Patients with Multiple Chronic Conditions (18 and over) | – | Yes | – | – | – |
| Child and Adolescent Well-Care Visits 3-21 (HEDIS WCV) | – | Yes | Yes | Yes | Yes |
| Developmental Screening in the First Three Years of Life (CMS Child Core C-DEV) | – | Yes | Yes | – | Yes |
| ACO All-Cause Readmissions (HEDIS PCR) | – | – | – | Yes | – |
| Initiation of Substance Use Disorder Treatment (Quality ID# 305-Medicare)
Initiation of Substance Use Disorder Treatment (HEDIS IET- Medicaid, MVP, PHM) |
Yes | Yes | – | Yes | Yes |
| Engagement of Substance Use Disorder Treatment (Quality ID# 305-Medicare)
Engagement of Substance Use Disorder Treatment (HEDIS IET-Medicaid, MVP, PHM) |
Yes | Yes | – | Yes | Yes | Follow Up after ED Visits for Patients with Mulitiple Chronic Conditions (HEDIS FMC) | – | – | Yes | – | Yes |
| Follow-Up After Hospitalization for Mental Illness (7 Days) (HEDIS FUH) | – | Yes | – | Yes | Yes |
| Breast Cancer Screening (HEDIS BCS-E) | – | – | – | Yes | – |
| Cervical Cancer Screening (HEDIS CCS-E) | – | – | – | Yes | – |
| Medicare Annual Wellness Visit | – | – | – | – | Yes |
| Influenza Immunization (Quality ID# 110) | Yes | – | – | – | – |
| Colorectal Cancer Screening (Quality ID# 113, HEDIS COL-E) | Yes | – | Yes | Yes | – |
| Tobacco Use Assessment and Cessation Intervention (Quality ID# 226) | Yes | Yes | – | – | – |
| Screening for Clinical Depression and Follow-Up Plan (Quality ID# 134) | Yes | Yes | – | – | – |
| Diabetes Hemoglobin (HbA1c) Poor Control (>9.0%) (Quality ID#001) | Yes | – | – | – | – |
| Glycemic Status Assessment for Patients with Diabetes (HEDIS GSD) | – | Yes | Yes | Yes | – |
| Hypertension: Controlling High Blood Pressure (Quality ID# 236, HEDIS CBP) | Yes | Yes | Yes | Yes | Yes |
| CAHPS Patient Experience | Yes | Yes | – | Yes | – |
To find information on each of these 2025 annual quality measures, please visit the OneCare secure portal. There you will find measure specification booklets that contain individual provider tip sheets for each payer program that outline important information for all claims and clinical quality measures. These helpful tools can be found on the portal under the “Quality” category.
2025 Population Health Model Measures
| 2025 Population Health Model Measure | Measure Description | 2025 Target Rate | Percentile Benchmark |
|---|---|---|---|
| Child and Adolescent Well-Care Visits 3-21 (HEDIS WCV) | The percentage of members 3-21 years of age who had at least one comprehensive well care visit with a PCP or an OB/GYN practitioner during the measurement year. | 64.74 % | Medicaid 90th (3-21) |
| Developmental Screening in the First Three Years of Life (CMS Child Core C-DEV) | The percentage of children screened for risk of developmental, behavioral, and social delays using a standardized screening tool in the 12 months preceding, or on their first, second, or third birthday. | 51.60% | Medicaid Child Core Set 75th |
| Medicare Annual Wellness Visit | A yearly check-up for Medicare enrollees assisting participants the opportunity to gain information about their patients, including medical and family history, health risks, and specific vitals. A proactive approach to encourage patients to be proactive about their health and engage in preventive health services. | 56.9% | National ALL ACO Benchmarking - 50th |
| Hypertension: Controlling High Blood Pressure (Quality ID# 236, HEDIS CBP) | The percentage of patients 18-85 years of age who had a diagnosis of hypertension and whose blood pressure (BP) was adequately controlled (<140/90 mmHg) during the measurement. | 69.37 % | Medicaid 75th |
| Initiation of Substance Use Disorder Treatment (HEDIS IET) | The percentage of new substance use disorder (SUD) episodes that result in treatment initiation and engagement. Two rates are reported: Initiation of SUD treatment (within 14 days) and Engagement of SUD treatment (within 34 days of initiation). | 44.51% | Medicaid 50th |
| Engagement of Substance Use Disorder Treatment (HEDIS IET) | The percentage of new substance use disorder (SUD) episodes that result in treatment initiation and engagement. Two rates are reported: Initiation of SUD treatment (within 14 days) and Engagement of SUD treatment (within 34 days of initiation). | 19.01% | Medicaid 75th |
| Follow Up after ED Visits for Patients with Multiple Chronic Conditions (HEDIS FMC) | The percentage of emergency department (ED) visits for members ages 18 and older who have multiple high-risk chronic conditions who had a follow up service within 7 days of ED visit. | 56.50 % | NCQA National Average Medicare PPO |
| Follow-Up after ED Visit for Substance Use - 30-Day (HEDIS FUA) | The percentage of emergency department visits for members 13 years and older with a principal diagnosis of substance use disorder, or any diagnosis of drug overdose, for which there was a follow-up. | 49.40% | Medicaid 75th |
| Follow-Up after ED Visit for Mental Illness -30 Day (HEDIS FUM) | The percentage of emergency department visits for members 6 years and older with a principal diagnosis of mental illness or intentional self-harm, who had a follow-up visit for mental illness. | 73.12% | Medicaid 90th |
| Follow-Up After Hospitalization for Mental Illness (7 Days) (HEDIS FUH) | The percentage of discharges for members 6 years of age and older who were hospitalized for treatment of selected mental illness or intentional self-harm diagnosis and who had a follow-up visit with a mental health provider. | 46.99% | Medicaid 75th |
To find information on each of the 2025 Population Health Model measures, please visit the OneCare secure portal where you will find the PY2025 Provider Tip Sheets that outline important information for all claims and clinical quality measures. They can be found under the “PHM” category.
Self-Reporting Dates and Deadlines
To qualify for the Population Health Model (PHM) payments and bonus payments, attributing primary care providers must complete mandatory online attestations and self-reporting in four areas: Hypertension control, Mental Health Screening, Social Determinants of Health Screening and Care Coordination activities.
For each data collection report, OneCare will send this initial email request two weeks before the due date, and a reminder email one week before.
Self-Reporting for Hypertension: Controlling High Blood Pressure (Quarterly)
| Frequency of Reporting | Email Request* | Reporting Period | Reporting Deadline |
|---|---|---|---|
| Quarter 1 | March 3, 2025 | March 1, 2024 – February 28, 2025 |
March 14, 2025 |
| Quarter 2 | June 2, 2025 | June 1, 2024 – May 31, 2025 |
June 13, 2025 |
| Quarter 3 | September 1, 2025 | September 1, 2024 – August 31, 2025 |
September 12, 2025 |
| Quarter 4 | January 5, 2026 | January 1, 2025 – December 31, 2025 |
January 16, 2026 |
Email request* = This is the date you can expect to receive an email from OneCare with a link to a specific reporting form for your practice to submit data
Self-Reporting for Mental Health Screening Initiative (Biannually):
| Frequency of Reporting | Email Request* | Reporting Period | Reporting Deadline |
|---|---|---|---|
| Mid-year | June 2, 2025 | January 1, 2025 – May 31, 2025 |
June 13, 2025 |
| End-of-year | January 5, 2026 | January 1, 2025 – December 31, 2025 |
January 16, 2026 |
Email request* = This is the date you can expect to receive an email from OneCare with a link to a specific reporting form for your practice to submit data
Self-Reporting for Health-Related Social Needs (Biannually):
| Frequency of Reporting | Email Request* | Reporting Period | Reporting Deadline |
|---|---|---|---|
| Mid-year | June 2, 2025 | January 1, 2025 – May 31, 2025 |
June 13, 2025 |
| End-of-year | January 5, 2026 | January 1, 2025 – December 31, 2025 |
January 16, 2026 |
Email request* = This is the date you can expect to receive an email from OneCare with a link to a specific reporting form for your practice to submit data
Self-Reporting for Care Coordination (Triannually):
| Frequency of Reporting | Email Request* | Reporting Period | Reporting Deadline |
|---|---|---|---|
| Triannual 1 | April 4, 2025 | January 1, 2025 – March 31, 2025 | April 18, 2025 |
| Triannual 2 | August 8, 2025 | April 1, 2025 – July 31, 2025 | August 22, 2025 |
Email request* = This is the date you can expect to receive an email from OneCare with a link to a specific reporting form for your practice to submit data
Medicare 3-Day SNF Waiver Quarterly Audit Dates (Quarterly):
| Frequency of Reporting | Email Request* | Reporting Period | Reporting Deadline |
|---|---|---|---|
| Quarter 1 | April 1, 2025 | January 1, 2025 – March 31, 2025 | Step 1: April 8, 2025 Step: 2: April 22, 2025 |
| Quarter 2 | July 1, 2025 | April 1, 2025 – June 30, 2025 | Step 1: July 8, 2025 Step 2: July 22, 2025 |
| Quarter 3 | October 1, 2025 | July 1, 2025 – September 30, 2025 | Step 1: October 8, 2025 Step 2: October 22, 2025 |
| Quarter 4 | January 1, 2026 | October 1, 2025 – December 31, 2025 | Step 1: January 8, 2026 Step 2: January 22, 2026 |
Email request* = This is the date you can expect to receive an email from OneCare with the audit template for your site to complete.
OneCare Care Coordination Program Resources
OneCare’s care coordination model supports a strong relationship between the patient, their primary care provider, and other members of a person’s care team.
Strong performance in care coordination by our OneCare network is possible by:
- Employment of evidence-based patient centered care coordination including designation of a lead care coordinator, shared care planning, and care team conferences.
- Improvement in care managed rates for individuals by regularly reviewing patient panels, including those with complex needs experiencing avoidable healthcare utilization, for timely outreach and engagement in care coordination.
- Complete, accurate, and timely tri-annual care coordination reporting of care managed attributed lives and associated data.
- Timely response to care coordination validation audits demonstrating supportive evidence of data submitted with tri-annual reports.
- Ongoing care coordinator professional development through attendance at OneCare education sessions and/or other evidence-based care coordination offerings.
Arcadia Impact Program
We know that individuals with multiple chronic conditions, limited functional status and/or psychosocial challenges are vulnerable and more likely to experience adverse events and poor health outcomes. We also know that individuals who are at risk for increasing or worsening health conditions such as multiple chronic conditions, limited function status and/or psychosocial challenges are vulnerable and often benefited by enrollment in a care management program.
The Arcadia Impact Program utilizes a sophisticated risk stratification tool available in OneCare Vermont’s data analytics platform, Arcadia, to provide visibility at the patient level into the degree of impact a care management intervention is likely to have on important health outcomes. These outcomes include: emergent inpatient admissions, total cost of care, and preventable emergency department visits for the individual.
Arcadia combines multiple factors, including Emergency Department utilization, healthcare costs, and unplanned admissions coupled with social and economic factors influencing health to create the Arcadia Impact Program designation for each patient including:
- Demographics, such as age and sex
- Morbidity, as reflected by concurrent risk
- Utilization, as reflected by outpatient and inpatient events (from claims data)
- Disease State, as reflected by types of conditions
- Socioeconomic Status, as reflected by census data on local conditions
- Care Coordination, as reflected by provider mix (from claims data)
- Health Condition, as reflected by labs, screenings, and observations
The resulting Arcadia Impact Program designations below are visible in the system at the individual patient level to inform care management program resource planning, as well as effective outreach and engagement of individuals in a population:
- Very Strong Potential
- Strong Potential
- Good Potential
- Some Potential
- Not Recommended
Tri-Annual Care Coordination Reporting Details:
This reporting template ensures the care coordination data is completed in a uniform manner. This completed template is to be uploaded to the OneCare portal by participating organizations three times per year.
Organizations may use a report generated by an electronic medical record or the Excel spreadsheet provided, as long as the format and data are exactly as specified in the reporting guidelines.
Please note that the template is formatted to include specific responses and orders of date. This cannot be changed or the data will not be accepted.
Each organization is required to submit the tri-annual reporting template. Periodically, a narrative report may also be requested with the tri-annual reporting template.
Annual Validation Audit Guidelines:
Every organization will be audited at least once per year. The audits seek additional information that supports and validates self-reported care management data.
Audit Process:
- Network organizations participating in the Population Health Model submit triannual care coordination reporting inclusive of a list of care managed attributed lives and interventions.
- Organizations are notified of audit and validation template is provided.
- Selected organizations are audited on 10 individuals or the maximum number available.
- Target areas of validation audit per care managed individual:
- Evidence of lead care coordinator
- Evidence of shared care plan
- Evidence of cross organizational collaboration if so reported
- Evidence of encounter frequency
- Evidence of a care team conference if so reported
- Organizations have four weeks to complete and submit documentation requested.
- Organizations are responsible for providing adequate evidence in 90% or more of targeted areas.
- If an organization is not able to provide 90% of adequate evidence, they will be subject to additional action based on the percentage of evidence provided.
- If the organization is not responsive or does not demonstrate improvement, PHM payments may be affected.
Care Coordination Program Definitions and Reference Guide
Find at-a-glance program definitions and care coordination expectations and requirements:
Care Coordination Toolkit:
Find tools and resources for implementing and providing ongoing care coordination in your practice:
Data Performance Reports Release Dates
Each quarter, OneCare posts data performance reports to our secure portal.
OneCare network providers will receive notification in the monthly Need-to-Know from Your ACO e-newsletter that the reports are coming soon and/or available on the portal, as well as through direct notification in one-on-one meetings and communications with your contacts on our team.
*Dates subject to change – dates will be updated below and you will be notified via email.
| Name of Report | Frequency | Release Date |
|---|---|---|
| Primary Care Data and Analytics Report | Quarterly | January 15, 2025, April 15, 2025, July 15, 2025, October 15, 2025 |
| Health Service Area Data and Analytics Report | Quarterly | January 15, 2025, April 15, 2025, July 15, 2025, October 15, 2025 |
| Executive Summary Data and Analytics Report | Quarterly | January 15, 2025, April 15, 2025, July 15, 2025, October 15, 2025 |
| Care Coordination Summary Report | Tri-annually | March 14, 2025 June 13, 2025 November 14, 2025 |
| Care Coordination Attributed Members Report | Tri-annually | March 14, 2025 June 13, 2025 November 14, 2025 |
| Care Coordination Detailed Activity Report | Tri-annually | March 14, 2025 June 13, 2025 November 14, 2025 |
| Mental Health Screening Rates by Practice | Mid-Year and End-of-Year | July 15, 2025, January 23, 2026 |
Webinars, Trainings, and Consultations
To support our OneCare network in having the information, tools, and resources to be successful in the OneCare accountable care organization and transform the way health care is paid for and delivered, we host a series of webinars, trainings, and consultations appropriate for various segments of our network.
You will be emailed either calendar appointments or invitations to register, depending on the offering.
*Dates subject to change – dates will be updated below and you will be notified via email.
General Webinars and Trainings – Upcoming
| Webinars and Trainings | Frequency | Registration or Recording Link | Upcoming Dates |
|---|---|---|---|
| 2025 Care Coordination Core Team meeting | Quarterly | By Invitation | Thursday, July 17, 2025 from 12:00 – 1:00 pm |
| 2025 Care Coordination Core Team meeting | Quarterly | By Invitation | Thursday, September 18, 2025 from 12:00 – 1:00 pm |
| 2025 Care Coordination Core Team meeting | Quarterly | By Invitation | Thursday, November 13, 2025 from 12:00 – 1:00 pm |
General Webinars and Trainings – Passed
| Webinars and Trainings | Frequency | Registration/Recording Link and Associated Resources | Occurred on |
|---|---|---|---|
| Value-Based Care Webinar: Initiation and Engagement of Substance Use Disorder Network Spotlight | As-needed | View recording here | July 2, 2024 |
| Social Determinants of Health/Health Related Social Needs Screening Network Spotlight Webinar | As-needed | View recording here | September 24, 2024 |
| PY2023 Annual Quality Measure Results Overview | Annually | View recording here | October 29, 2024 |
| SNF Waivers and Swing Bed Education Session 1 | As-needed | View recording here | February 18, 2025 |
| SNF Waivers and Swing Bed Education Session 2 | As-needed | View recording here | February 19, 2025 |
| 2025 Care Coordination Core Team meeting | Quarterly | n/a | Thursday, April 17, 2025 from 12:00 – 1:00 pm |
| Increasing Equity and Access in Panel Management | As-needed | View Recording Here – Health Equity & Access Population Health Playbook – PDF |
Tuesday, April 29, 2025 from 12:00 – 1:00 pm |
| 2025 Controlling High Blood Pressure (HTN) |
As-needed | View recording here | Wednesday, May 14, 2025 from 12:00 – 1:00 pm |
Executive HSA Consultations
| HSA(s) | Frequency | Registration | Upcoming Dates/Times |
|---|---|---|---|
| Bennington/Brattleboro | Bi-annually | By Outlook invitation | Tuesday, May 6, 2025 |
| Berlin/Middlebury | Bi-annually | By Outlook invitation | Thursday, May 8, 2025 |
| Burlington | Bi-annually | By Outlook invitation | Tuesday, May 13, 2025 |
| Lebanon, Windsor and Randolph | Bi-annually | By Outlook invitation | Thursday, May 22, 2025 |
| Newport/St. Johnsbury | Bi-annually | By Outlook invitation | Thursday, May 29, 2025 |
| Rutland/Springfield | Bi-annually | By Outlook invitation | Tuesday, June 3, 2025 |
| St. Albans/Morrisville | Bi-annually | By Outlook invitation | Thursday, June 5, 2025 |
Population Health Model Payments Overview
(Updated for 2025)
Population Health Model
Primary Care Payments
- Fixed monthly base payment of $4.00 per member, per month (PMPM)
- Bonus payment amount of $5.25 PMPM divided equally across all applicable measures
- Monthly base payments are made to all providers from January through December 2025
- All providers have the opportunity to earn their full bonus potential based on PHM measure performance for the entire 2025 performance year
- Interim monthly PHM bonus payments begin in July 2025
- Year-end reconciliation of PHM measure performance and bonus payments in approximately April 2026 (based on performance from 1/1/2025 – 12/31/2025)
- PHM measures are applicable to all practices with one or more patients in the denominator
- Example: if a practice achieves 4 targets out of 7 applicable measures, PHM bonus rate would be $5.25/7 = $0 .75 x 4 = $3.00 PMPM, if a practice achieves 4 targets out of 4 applicable measures $5.25/4 = $1.31 x 4 = $5.25 PMPM
1 – Contingent upon satisfying Eligible Participant Obligations (see PHM Policy)
2 – Italicized date ranges are projected ranges for claims-based measures only, subject to data availability
3 – Performance-based (not guaranteed); performance and monthly bonus payment amount updated quarterly in July and October
4 – Full PHM bonus potential available ($3.15 PMPM X 12 mos. for PY24; $5.25 PMPM X 12 mos. for PY25)
Pay for Improvement Incentive
Find full guidelines for this additional bonus opportunity here: Pay for Improvement Incentive
Payments for Designated Agencies
- Monthly PMPM base payments based on each DA’s share of the total value of claims for care provided by DA’s to attributed lives under current ACO programs
- Bonus payments for meeting or exceeding FMC target in the PHM
- Additional $500k in PHM bonus funding for performance in DA specific measures (FUA, FUM, FUH)
Payment for Home Health and Hospice
- Monthly PMPM base payments based on agencies share of total value of claims for care provided by HHH agencies to attributed lives under current ACO programs
- Bonus payments for meeting or exceeding FMC target in the PHM
Payment for Area Agencies on Aging
-
Monthly PMPM payments based on each AAA’s relative share of assigned attributed lives in the AAA’s health service area
-
No bonus amount in 2025, money has been reallocated to “base” payments
Eligible Participant, Preferred Provider, and Collaborator Obligations:
- Participation in PHM and acceptance of PHM payments by Eligible Participants, Preferred Providers, and certain Collaborators constitutes an express agreement to align goals and priorities with the stated goals and priorities of OneCare, which includes, at minimum, working with OneCare to meet or exceed cost and quality targets under ACO Programs.
- All Eligible Participants shall provide a medical home for Assigned Attributed Lives, as defined in 18 V.S.A. § 704, as an indication the Participant is committed to managing their patient population with high-quality, cost-effective, team-based care.
- Eligible Participants, Preferred Providers, and Collaborators must actively participate in and report on care coordination activities, per the requirements set forth in policy and as outlined below, to receive any PHM payments under this policy. The guidance provided on the Provider Resource Center is overseen by OneCare’s Population Health Strategy Committee and will be updated with 2025 guidance on the OneCare website and promoted to participating members or upon request no later than November 1, 2024.
Provider Accountabilities
(Updated for 2025)
Accountabilities Related to Health Care Transformation and Innovation:
Promote strong performance in health care delivery in furtherance of achieving OneCare’s programmatic and strategic goals; embrace and demonstrate innovation in OneCare’s Population Health Model; integrate the “care model” (prevention, care coordination and care management), quality improvement, and health equity.
Provider Accountability: Health Equity
Health Related Social Needs/Social Determinants of Health Screening
- Incorporate SDOH screening into yearly patient visits using the CMS Health-Related Social Needs Screening Tool and electronic data entry in an EHR.
- Make SDOH screening results essential to holistic patient care.
- Electronically report SDOH screening rates to OneCare using the CMS tool (questions 1-15).
Mental Health Screening
- Participants must administer mental health screening annually for depression and suicide risk for patients twelve years of age and older
- A mental health follow-up plan for patients that screen positive must be documented
- Participants must self-report mental health screening rates to OneCare twice annually via electronic submission
Provider Accountability: Care Model and Quality
OneCare will provide performance reporting and improvement programs
- Actively pursue meeting targets in 75%+ of Population Health Model quality metrics for which the practice qualifies
Provider Accountability: Total Cost of Care Improvement
- Meet or exceed OneCare’s target for follow-up after emergency department visits for high-risk patients with multiple chronic conditions (HEDIS FMC)
Accountabilities Related to Culture:
Promote an engaged and aligned network to achieve OneCare’s goals.
Provider Accountability: Good OneCare Citizenship
Commit to OneCare’s values and act in alignment with them.
Provider Accountability: Engagement
Participate in at least 50% of OneCare value-based care meetings annually:
- HSA Executive Consultations
- PHM Performance Review
- Care Coordination Meetings
Provider Accountability: Technology
By 1/1/25, use an Electronic Health Record compatible with CMS 2015 CEHRT standards and pursue advanced interoperability for data exchange with OneCare.
Regional Clinical Representatives
Regional clinical representative (RCR) goals are to:
- Champion for performance improvement in PHM measures
- Use data to identify practice needs for a performance improvement plan
- Support practice through partnership with a OneCare team member to identify opportunities for improvement
- Track and review performance improvement plans relative to PHM measures
The current regional clinical representatives are:
Rick Dooley, PA-C
Thomas Chittenden Health Center
Alder Brook Family Health
Essex Pediatrics
Evergreen Family Health Lakeside Pediatrics
Richmond Family Medicine PLLC
Thomas Chittenden Health Center, PLC
Toby Sadkin, MD
Primary Care Health Partners
Cold Hollow Family Practice
Brattleboro Primary Care, 2 sites
Monarch Maples Pediatrics, 2 sites
Mt. Anthony Primary Care
St. Albans Primary Care
Timber Lane Pediatrics, 3 sites
Jeri Wohlberg, FNP
Northern Counties Health Care, Inc
Concord Health Center
Danville Health Center
Hardwick Health Center
Island Pond Health Center
Kingdom Internal Medicine
NVRH Corner Medicine
NVRH St. Johnsbury Pediatrics
St. Johnsbury Community Health Center
Lance Broy, MD
Lamoille Health Partners
Lamoille Health Family Medicine – Cambridge
Lamoille Health Family Medicine – Morrisville
Lamoille Health Family Medicine – Stowe
Lamoille Health Pediatrics
North Country
Kerry Goulette, PA-C
Community Health Centers Burlington
CHC Burlington (Riverside)
CHC Champlain Islands
CHC Essex
Good Health Center
South End Health Center
Winooski Family Health
Job Larson, MD
Community Health Centers of Rutland Region
Allen Pond Community Center
Brandon Medical Center
Castleton Family Health Center
CHCRR Pediatrics
Community Health North Main Street
Drs. Peter and lisa Hogenkamp
Mettowee Valley Family Health Center
Rutland Community Health Center
Shorewell Community Health Center
Aida Advic, MD
Brattleboro Memorial Hospital
Brattleboro Family Medicine
Brattleboro Internal Medicine
Maplewood Family Practice
Putney Health Center
Windham Family Practice
Keith Robinson, MD
Jeremiah Eckhaus, MD
Central Vermont Medical Center PHSO
University of Vermont Health Network PHSO
CVMC Adult Primary Care – Barre
CVMC Family Medicine – Berlin
CVMC Family Medicine – Mad River
CVMC Family Medicine – Main Campus
CVMC Adult Primary Care – Waterbury CVMC Green Mountain Family Medicine – Montpelier
CVMC Pediatrics Primary Care – Berlin PMC Primary Care – Brandon
PMC Primary Care – Middlebury
PMC Primary Care – Vergennes
UVM Children’s Hospital Pediatrics
UVMMC Adult Primary Care – Burlington
UVMMC Adult Primary Care – Essex
UVMMC Adult Primary Care – South Burlington
UVMMC Adult Primary Care – Williston
UVMMC Family Medicine – Colchester
UVMMC Family Medicine – Hinesburg
UVMMC Family Medicine – Milton
UVMMC Family Medicine – South Burlington
Business Closure Need-to-Know
As a reminder, OneCare will wind down operations by the end of this year. This section of the resource center will be used to regularly add content between now and our closure to ensure our network has the information and guidance they need to prepare for the transition.
Some items may require action before year-end, while others are simply for your awareness. We’ll continue updating this section in the coming months—watch your inbox for direct emails from our team and our monthly Need-to-Know from Your ACO, released on the first Tuesday of each month.
Announcement
Retaining the Capabilities of Certified ACOs
A memo sent to Vermont’s Agency of Human Services (AHS) and other healthcare stakeholders
In response to recent legislation and to support the evolution of healthcare initiatives in Vermont, this memo catalogues some of work OneCare currently performs on behalf of providers and the patients they serve, explaining components of OneCare’s work and the value it brings to our healthcare system. The intent of the memo is to be constructive and support all stakeholders through this transition. OneCare is available to field questions and help others explore opportunities to sustain this important work beyond the wind down of OneCare operations at the end of 2025.
Finance
Remainder of 2025
Expect more frequent adjustments to monthly prospective payments (non-core and GPP) in order to reduce the need for reconciliation activity post-dissolution of the programs on January 1, 2026.
December 2025
The December payment will be the final regular payment from OneCare (FPP Hospitals, CPR Primary Care Practices, and PHM Program Participants) until reconciling activity in April 2026. FPP Hospitals and CPR Practices only should prepare for the end of year cashflow transition:
- On the fourth Friday of December (December 26, 2025): Your organization will receive its final fixed payment for services provided in December.
- On January 1, 2026: Your organization will return to submitting claims for fee-for-service payment. Consider ramping up clean claims practices as you return to episodic payment with an accounts receivable cycle.
April 2025
The April payment batch will include final PHM program payments and CPR program reconciliation. Expect to receive:
- Primary Care Providers: PHM reconciliation and pay-for-improvement payments
- DAs and HHHs: Year-end PHM bonus payments
- CPR Practices: Reconciliation of non-core and GPP to 105% of fee-for-service
July/August 2026
Medicare AIPBP settlement (first recon of 2025, second recon of 2024)
September/October 2026
Shared Savings and Shared Loss Settlements
Waivers
All waivers through OneCare CANNOT be legally used after December 31, 2025
Benefit Enhancement Waivers from the Centers for Medicare & Medicaid Services (CMS) as well as Fraud and Abuse Waivers such as Participant and/or Patient Incentive Waivers are only accessible through an accountable care organization and, therefore, will not be legally accessible after OneCare closes.
- What you need to do now: Make sure you understand which waivers your organization is currently utilizing and what it will mean for your operations and your patients when they end. Please plan ahead knowing these waivers will end on December 31, 2025.
Find here a list of all the waivers and potential impact on patients for which you should begin to prepare for. - What to expect from OneCare: Reminders will be sent in the last quarter of the year that these waivers will be ending.
Skilled Nursing Facilities and Swing Bed Contacts
In early June you received an email from our clinical program specialist, Tawnya Safer, reminding you that due to the fact that OneCare is winding down operations in 2025, effective 1/1/2026, the Medicare 3-Day Skilled Nursing Facility (SNF) waiver will no longer be able to be utilized. Please begin to plan for any patients or processes that may be affected. Also, please note that the Q4 audit will still happen in January 2026. Questions or concerns? Contact tawnya.safer@onecarevt.org.
Operations
July 2025 to December 31, 2025
Medicare Beneficiary Marketing Posters
The posters that announce your participation in the OneCare ACO are no longer required to be displayed.
- What you need to do now: Remove and discard the posters or other marketing materials you may have displayed that describe your participation in OneCare for the Medicare ACO program. These materials must be removed no later than December 31, 2025.
October 2025
Last Quarterly Organization Contact File Update from OneCare
October is the last time we will reach out to secure updated Contacts from your organization.
- What you need to do now: Share this information with appropriate staff in your practice so they are aware and can help us secure a final update of contacts for your organization in October. This final update will be used throughout our Payer Program settlement period into 2026.
- What to expect from OneCare: Email any additional contact changes to contracting@onecarevt.org. We will be able to incorporate these changes through close of business on December 18, 2025.
November 2025
This will be the last prompt from OneCare to update your Provider File information
This final update will carry us through the end of the calendar year 2025 and will be used for any financial runout business; no further updates beyond this will be necessary at the provider level.
- What you need to do now: Put on your radar that we will need your help with reviewing and returning your final Provider File on time. We will not have additional time to grant extensions. Watch for this email in November.
January 1 to December 31, 2026
To ensure we can make payments to you, submit any changes to legal business information
Beginning January 1, 2026, and throughout 2026, you will need to notify OneCare of any changes to your legal business information at least 45 days prior to the change occurring. This will ensure future payments for OneCare’s runout reconciliations reach you timely and accurately, and 1099 IRS reporting is accurately filed. These changes include any of the following:
- Closing or Selling your Organization
- Legal Business Name Change
- Tax Identification Number (TIN) Change
- Banking Information Change
- Leadership Change (CEO, CFO, COO)
- What you need to do from January 1 to December 31, 2026:
- For any of the changes like those listed above, submit this Legal Business Information Form at least 45 days before the change.
- Email the completed form to onecarevt@onecarevt.org.
Reporting
Population Health Model and Quality Reporting Requirements Continue
While OneCare is not engaging in new payer contracts for 2026, reporting on our 2025 Population Health Model programs will be required in 2026.
- What you need to do now: Review the previously established reporting deadlines here and mark your calendars.
- What to expect from OneCare: Email reminders about reporting two weeks ahead of each due date with instructions for submitting your results electronically or via the secure portal.
Compliance
Compliance Concerns?
OneCare workforce and participating network members both have a duty to report any possible misconduct or violation of law. If you have an OneCare-related compliance or privacy question or concern, you should:
- Report your concern to your organization’s compliance or privacy officer
- Report the concern through the OneCare Compliance Hotline.
OneCare Compliance Hotline:
802-847-7220 or Toll-free 877-644-7176 (Select Option 2)
OneCare Compliance Hotline Email:
OneCareVTHotline@OneCareVT.org
Or fill out our anonymous contact form.
Reports remain confidential and retaliation is prohibited.